original articleClinical Correlates

original article
Clinical Correlates of Surveillance Events Detected by National
Healthcare Safety Network Pneumonia and Lower Respiratory
Infection Definitions—Pennsylvania, 2011–2012
Isaac See, MD;1,2 Julia Chang, MD;3 Nicole Gualandi, RN, MS/MPH;1 Genevieve L. Buser, MDCM, MSHP;2,4
Pamela Rohrbach, RN, CIC;5 Debra A. Smeltz, RN;5 Mary Jo Bellush, MSN, CIC;6 Susan E. Coffin, MD, MPH;7
Jane M. Gould, MD;8 Debra Hess, RN, CIC;9 Patricia Hennessey, RN, BSN, MSN, CIC;8 Sydney Hubbard, MPH;7
Andrea Kiernan, MLT (ASCP), CIC;8 Judith O’Donnell, MD;10 David A. Pegues, MD;11 Jeffrey R. Miller, MD, MPH;12
Shelley S. Magill, MD, PhD1
objective. To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or
lower respiratory infection (LRI) surveillance events.
design. Retrospective chart review.
setting. A convenience sample of 8 acute-care hospitals in Pennsylvania.
patients. All patients hospitalized during 2011–2012.
methods. Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults
with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.
results. We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither
PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not
on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in
mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI.
Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI
patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.
conclusions. In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible
clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the
LRI definitions were implemented in 2015.
Infect Control Hosp Epidemiol 2016;37:818–824
In a recent point-prevalence survey of healthcare-associated
infections (HAIs) in the United States, HAI events fulfilling
then-current National Healthcare Safety Network (NHSN)
pneumonia (PNEU) and other lower respiratory infection
(LRI) surveillance definitions comprised the most common
group of HAIs identified.1 Although many HAI surveillance
and prevention efforts for respiratory events have focused on
device-associated infections, ie, ventilator-associated pneumonia
(VAP), recent data show that only 30%–40% of NHSNdefined
PNEU in adults are ventilator associated.1–3
In 2013, the NHSN transitioned from surveillance for VAP
to surveillance for ventilator-associated events because of
limitations of the traditional surveillance paradigm. Notably,
some of the signs and symptoms used for VAP surveillance
Affiliations: 1. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; 2. Epidemic Intelligence Service,
Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA; 3. UCLA Geffen School of Medicine,
Los Angeles, California; 4. Oregon Health Authority, Portland, Oregon; 5. Pennsylvania Department of Health, Harrisburg, Pennsylvania; 6. Excela Health
Westmoreland Hospital, Greensburg, Pennsylvania; 7. The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; 8. St. Christopher’s Hospital for
Children, Philadelphia, Pennsylvania; 9. Lancaster General Hospital, Lancaster, PA; 10. Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania;
11. University of Pennsylvania Health System, Philadelphia, Pennsylvania; 12. Office of Public Health Preparedness and Response, CDC, assigned to the
Pennsylvania Department of Health, Harrisburg, Pennsylvania.
PREVIOUS PRESENTATION: This study was presented in part in abstract 894 at the 2014 IDWeek conference, Philadelphia, Pennsylvania, on October 10, 2014.
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2016/3707-0011. DOI: 10.1017/ice.2016.74
Received December 29, 2015; accepted March 6, 2016; electronically published April 13, 2016
infection control & hospital epidemiology july 2016, vol. 37, no. 7
have been argued to be both non-specific and subjective in a
mechanically ventilated patient population, thereby potentially
including a significant proportion of patients who have noninfectious
or even nonspecific pulmonary conditions.4,5
Moreover, the clinical diagnosis of VAP itself is subject to

ผลลัพธ์ (อังกฤษ) 2:

Original Article
Clinical Correlates of Surveillance Events Detected by National
Healthcare Safety Network Pneumonia and Lower Respiratory
Infection-Definitions Pennsylvania, 2011-2012
See Isaac, MD; 1,2 Julia Chang, MD; 3 Nicole Gualandi, RN, MS / MPH; 1 Genevieve. L. Buser, MDCM, MSHP; 2,4
Pamela Rohrbach, RN, CIC; 5 Debra A. Smeltz, RN; 5 Mary Jo Bellush, MSN, CIC; Susan E. Coffin 6, MD, MPH; 7
Jane M. Gould. , MD; 8 Debra Hess, RN, CIC; 9 Patricia Hennessey, RN, BSN, MSN, CIC; 8 Sydney Hubbard, MPH; 7
Andrea Kiernan, MLT (ASCP), CIC; 8 Judith O'Donnell, MD; David 10. A. Pegues, MD; Jeffrey R. 11 Miller, MD, MPH; 12
Shelley S. Magill, MD, PhD1
Objective. To Determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or
Lower respiratory infection (LRI) surveillance events.
Design. Chart Retrospective review.
Setting. A Convenience sample of 8-acute Care hospitals in Pennsylvania.
Patients. All patients hospitalized during from 2,011 to 2012.
Methods. Medical records were reviewed from a Random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults
with ventilator-associated PNEU. Documented clinical diagnoses temporally corresponding to the LRI and PNEU events were Recorded.
Results. We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither
PNEU NOR LRI Case criteria. Differences interpreting radiology reports accounted for most misclassifications. PNEU of 81 events in adults not
on Mechanical Ventilation, had 84% clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 Adult LRI, 88% were in
mechanically ventilated patients and 35% had no corresponding clinical diagnosis (Infectious or noninfectious) documented at the time of LRI.
Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a. clinical pneumonia diagnosis. LRI of 61 pediatric
patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.
Conclusions. In adults and in children not on Mechanical Ventilation, Most Compatible NHSN-defined PNEU events corresponded with
clinical conditions documented in the Medical Record. In contrast, NHSN LRI events often did not. As a Result, substantial modifications to the
definitions LRI were implemented in 2015.
Infect Control Hosp Epidemiol the 2,016th; 37: eight hundred eighteen to eight hundred twenty-four
In a recent Point-prevalence Survey of Healthcare-associated
infections (HAIs) in the United States, fulfilling HAI events
then. -current National Healthcare Safety Network (NHSN)
pneumonia (PNEU) and Other Lower respiratory infection
(LRI) Most common surveillance definitions comprised the
Group of HAIs Identified.1 Although MANY HAI surveillance
and Prevention efforts have focused on events for respiratory
-associated infections Device. , IE, ventilator-associated pneumonia
(VAP), that only 30% -40 recent Data Show NHSNdefined% of
adults are in PNEU ventilator Associated.1-3
in 2,013th, transitioned from the NHSN surveillance for VAP
ventilator-associated events to surveillance for. because of
limitations of the Traditional Paradigm surveillance. Notably,
Some of the Signs and symptoms used for VAP surveillance
Affiliations: Division of Healthcare Quality Promotion 1., Centers for Disease Control and Prevention, Atlanta, Georgia; 2. Epidemic Intelligence Service,
Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA; 3. UCLA Geffen School of Medicine,
Los Angeles, California; 4. Oregon Health Authority, Portland, Oregon; 5. Pennsylvania Department of Health, Harrisburg, Pennsylvania; 6. Excela Health
Westmoreland Hospital, Greensburg, Pennsylvania; 7. The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 8. St. Christopher's Hospital for
Children, Philadelphia, Pennsylvania; 9. Lancaster General Hospital, Lancaster, PA; 10. Presbyterian Medical Center Pennsylvania, Philadelphia, Pennsylvania;
11. University of Pennsylvania Health System, Philadelphia, Pennsylvania; 12. Office of Public Health Preparedness and Response, CDC, assigned to the
Pennsylvania Department of Health, Harrisburg, Pennsylvania.
PREVIOUS PRESENTATION: This Study was in Part Presented in abstract 894 at the 2,014th IDWeek Conference, Philadelphia, Pennsylvania, on October 10,. 2014.
The Society for Healthcare Epidemiology © by 2016th of America. All rights reserved. 0899-823X / 2016 / 3707-0011. DOI: 10.1017 / Ice.2016.74
Received December 29, 2,015; accepted March 6, 2016; electronically Published April 13, 2016
Control & Hospital Epidemiology July the 2016th infection, Vol. 37, no. 7
have been argued to be both non-specific and subjective in a
mechanically ventilated Patient population, thereby potentially
including a significant proportion of patients have noninfectious Who
or even nonspecific pulmonary Conditions.4,5
Moreover, the clinical diagnosis of VAP itself is subject to.